Systematic review and meta-analysis of studies assessing the relationship between statin use and risk of ovarian cancer
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REVIEW ARTICLE
Systematic review and meta‑analysis of studies assessing the relationship between statin use and risk of ovarian cancer Sarah Irvin1 · Megan A. Clarke1 · Britton Trabert1 · Nicolas Wentzensen1 Received: 15 January 2020 / Accepted: 7 July 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose The link between lipid-stabilizing medications and epithelial ovarian carcinogenesis is incompletely understood. Statins may reduce ovarian cancer risk, but results are inconclusive. Methods We conducted a systematic review and meta-analysis of studies reporting associations between statin use and ovarian cancer risk in PubMed. Summary risk ratios (RRs) and confidence intervals (CIs) were calculated. Subgroup analyses by cancer histotype, statin class (lipo- or hydrophilic) and duration of statin use were conducted. Use of individual statins in populations was assessed to determine population-specific differences in statin types. Results Nine studies with 435,237 total women were included (1 randomized controlled trial (RCT); 4 prospective; 4 case–control). Statin use was associated with a reduced risk of ovarian cancer (RR 0.87, 95% CI 0.74–1.03) and risk was significantly reduced in populations with low pravastatin use (RR 0.83, 95% CI 0.70–0.99). Risk estimates varied by statin class (3 studies; lipophilic: RR 0.88, 95% CI 0.69–1.12; hydrophilic: RR 1.06, 95% CI 0.72–1.57) and cancer histotype (3 studies; serous: RR 0.95, 95% CI 0.69–1.30; clear cell: RR 1.17, 95% CI 0.74–1.86). Long-term use was associated with a reduced risk of ovarian cancer (RR 0.77, 95% CI 0.54–1.10) that further reduced when pravastatin use was low (RR 0.68, 95% CI 0.46–1.01). Between-study heterogeneity was high overall and in subgroups (I2 > 60%). Conclusion Statins may be associated with a reduced risk of ovarian cancer, but the effect likely differs by individual statin, duration of use and cancer histotype. Additional well-powered studies are needed to elucidate important subgroup effects. Keywords Ovarian cancer risk · Statin · Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors · Lipophilic · Hydrophilic · Histology · Review Abbreviations RR Risk ratio OR Odds ratio CI Confidence interval PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses NOS Newcastle-Ottowa Scale NEC New England Case–Control study
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10552-020-01327-8) contains supplementary material, which is available to authorized users. * Sarah Irvin [email protected] 1
Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
Introduction Ovarian cancer is the most fatal gynecologic malignancy worldwide with estimates of over 295,000 incident cases and > 184,000 deaths occurring in 2018 [1]. Currently, no effective screening approaches exist for detecting ovarian cancers [2, 3]. Lack of symptoms early in the disease process leads to > 70% of cases i
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